What's New in Neurofeedback

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  Links at http://www.sciencedaily.com/news/mind_brain/

The Society for the Advancement of Brain Analysis (SABA) held its 7th annual conference in Sarasota last week. It was one of the most successful meetings, with notable speakers drawn from neuroscience.

Elkhonon Goldberg, author of Wisdom Paradox and The Executive Brain, both books I've read recently and recommend, discussed the functional homogeneity and heterogeneity of the frontal lobes. His most interesting insights was that the full range of executive functions correspond to the functional heterogeneity of the prefrontal cortex and he demonstrated gender differences in the dorsolateral frontal lobe (DLFC): to force men to be field dependent (sensitive to context), you must knock out the right DLFC; women become field dependent if either left or right DLFC is impaired. Later, in a 2nd talk, he addressed how traditional approaches to understanding attention deficits and memory disorders, that have focused on the subcortex, the mesial temporal lobes and the cyngulate gyrus were incomplete, and showed data relating frontal lobes and brain stems.

Mario Beauregard followed with his approach to integrating neurotherapy into the larger psychotherapeutic field. He tested the effect of a QEEG-guided psychoneurotherapy (PNT) upon brain electromagnetic tomography in 22 individuals with major depressive disorder. Training was reduction of high-beta (18-30Hz) activity in right fronto-temporal/paralimbic regions and BDI-II scores dropped signifiantly in response to training and 20 out of 27 (74%) participants no longer meet DSM-IV criteria for MDD after the study. Absolute power of high-beta dropped in right lateral prefrontal cortex, right orbitofrontal cortex, right insula, right subgenual cingulate cortex and right anterior temporal pole.

Barry Sterman and David Kaiser (myself) discussed QEEG analysis of frontal lobe issues. We focused on functional connectivity, which the entire field has recognized as a central principle of brain maturation. Coherence and comodulation of low and moderate frequencies were found to increase with age at most sites in a sample of 101 children and adults. Of interest were frequencies modulated by thalamocortical and corticothalamic collaboration (4-30 Hz). Site-centered comodulation increased consistently with age at all sites whereas site-centered coherence only increased with age at posterior sites. Both measures evaluated site-specific brain immaturity in children and adults. A model that associates coherence with feedforward activity and comodulation with feedback activity of the brain was proposed.

Bill Lambos discussed how the clinical interview and relevant neuropsychological testing serve as independent and convergent sources of data in producing a comprehensive evaluation of client condition. Client history and neuropsychological abnormalities help disambiguate EEG findings. Johanne Levesque, who will replace Tim Tinius as one of the editors of Journal of Neurotherapy, presented reviewed the literature of neurofeedback treatment in children with AD/HD or learning disability and discussed recent fMRI findings after EEG training. Joel Lubar reviewed the history of studies regarding quantitative EEG, LORETA, and neurofeedback relevant to ADHD. Denise Malkowitz MD presented a remarkable neurofeedback outcome with severe brain damage and seizures.

Barry Sterman presented "The SMR Story: Sleep, Attention and Motor Regulation". Given the significance of the origin of SMR training, here is his abstract unexcerpted: "The discovery of an EEG rhythmic pattern in the sensorimotor area of cortex in alert but motionless cats, dubbed the Sensorimotor Rhythm, or SMR, was of particular interest because of its similarity to the unique “spindle-burst” pattern seen in the EEG of cats and humans during quiet sleep (Sterman & Wyrwicka, 1967). Both were in the 12-15 Hz frequency range over this general region and both were associated with the absence of spontaneous motor behavior. Additionally, the SMR appeared when animals were trained to suppress a learned motor response. To test the possibility that the changes in motor regulation in both states were related, a study was carried out in which cats were trained to produce the SMR directly in an operant conditioning paradigm, and sleep EEG and structure were measured before and after this training (Sterman et al., 1970). When compared to an alternate EEG training condition in a counterbalanced, crossover design, sleep spindle density was significantly increased and the duration of sleep periods prolonged only following the SMR training condition. A follow-up study with random assignment and double-crossover design provided SMR and control EEG training conditions to human subjects. Sleep studies obtained before and after these training periods revealed a significant and unique increase in sleep spindle density specifically following SMR training. Collectively, these finding suggested a functional link between the SMR and sleep-spindle EEG patterns that was subsequently investigated by others. Hauri (1981) found that SMR neurofeedback training significantly improved the sleep of so-called “idiopathic” insomniacs who were not suffering from stress or transient tension. More recently Verstraeten, in a blinded, randomized, placebo controlled study, found that SMR training sessions prior to sleep significantly improved sleep latency, sleep stability, and sleep efficiency in a group of healthy adults, while Shabus and Hoedlmoser obtained similar results in a randomized, controlled study of SMR training and sleep but also demonstrated a significant increase in sleep SMR frequency and spindle number. Further they found significant improvements in memory performance in SMR-trained subjects after sleep (papers submitted, 2008). The involvement of SMR training in motor regulation and learning potentiation appears to mediate these outcomes. "

News & Reviews NEW BOOKS

The Spiritual Brain: A Neuroscientist's Case for the Existence of the Soul
by Mario Beauregard, Denyse O'Leary
A review of scientific investigation into mysticism and modern forays into finding where God comes into the brain (everywhere?). --www.amazon.com/exec/obidos/ASIN/0195156307/eegspectrum

The Executive Brain: Frontal Lobes and the Civilized Mind
by Elkhonon Goldberg
A review of frontal lobe function for layperson and scientist alike. --www.amazon.com/exec/obidos/ASIN/0195156307/eegspectrum

The Wisdom Paradox: How Your Mind Can Grow Stronger As Your Brain Grows Older
by Elkhonon Goldberg
Explains how come we get smarter the longer we are out of school. --www.amazon.com/exec/obidos/ASIN/1592401872/eegspectrum

Resting electroencephalogram asymmetry and posttraumatic stress disorder. : PTSD sufferers do not differ from controls on resting EEG asymmetry. http://www.ncbi.nlm.nih.gov/pubmed/18404640

Emotion and resilience: hemispheric electroencephalogram asymmetry : EEG asymmetry across central cortex distinguished resilient from nonresilient children. Resilience, maltreatment status, and gender interacted for asymmetry at anterior frontal electrodes. http://www.ncbi.nlm.nih.gov/pubmed/17705904

Regional brain electrical activity in posttraumatic stress disorder after motor vehicle accident. : Exposure to trauma-related material produced enhanced right anterior and posterior activation in PTSD sufferers. Symptomatic motor vehicle survivors exhibit right hemisphere activation to traumatic information. http://www.ncbi.nlm.nih.gov/pubmed/17100526

As we continue to funnel our children's college fund into the Middle East, with every dollar spent fighting the relic radiation of the holy war begun by Moses when he left Goshen for Canaan now IOU'd to Eastern Palaces (China), we as clinical neuroscientists and therapists need to redress the ongoing aftermath to the personnel fighting these wars. (Military-related references were provided by Col Stetz and Col Russo.)

Nearly 1 in 5 warfighters returning from Operation Iraqi Freedom (OIF) screen positively for stress, as do 1 in 9 returning from Operation Enduring Freedom (OEF) (Hoge et al., 2004). Untreated stress impairs attention and mental flexibility (Brandes et al., 2002; Russo, Stetz, & Thomas, 2005), making it difficult to screen out irrelevant sensory cues (Neylan, et al., 1999). Stress makes people especially sensitive to new information so that it interferes with facts and procedures (Vasterling et al, 1998) and individuals suffering from PTSD are slower and less accurate in detecting targets (Veltmeyer et al., 2005). To achieve situational awareness dominance, our warfighters must stay focused and alert in the modern battle space and these requires inoculation to stress reactions and treating those already compromised by stress.

Critical incident stress debriefing (CISD) has had limited success in preventing stress reactions. Psychological debriefings produce few long-lasting effects (Kavanagh, 2006). Psychotherapy and medication fare no better in alleviating the aftermath of traumatic stress: less than half of those who enter psychotherapy improve, and antidepressant medications fare no better (Bradley et al, 2005; Hamner, Robert, & Frueh, 2004). Stress and depression are common reasons why warfighters are medically evacuated from theaters (Stetz et al., 2005).

In order to effectively treat posttraumatic stress we need to understand its neurobiology. Neuroimaging suggests that traumatic stress acts as a partial callosotomy, disconnecting left and right cortices as if by surgery (Karl et al., 2006; Teicher et al., 2002; De Bellis & Keshavan, 2003). The corpus callosum connects a billion neurons in the one hemisphere to a billion neurons in the other via 200 million axons (Aboitiz et al., 1992). Traumatic stress significantly prunes the anterior and midsection of this pathway (Zeitlin et al., 1989; Villarreal et al., 2004), resulting in a loss of connectivity which presents itself as deficits in memory, emotional regulation, and social relations as well as a decline in left hemisphere dominance (Zaidel & Iacoboni, 2003). Left hemisphere dominance is typical for members of industrial societies whereas right hemisphere dominance is typical of pre-industrial and low population density cultures (Rabe et al., 2006a; Metzger et al., 2004; Saltzman et al., 2006; Spivak et al., 1998; TenHouten, 1985; 1986). The left hemisphere provides our analytical, reductionistic competence, the right hemisphere our emotional and perceptual skills. PTSD patients often rely on more aboriginal modes of processing as evidence by impairments in visuo-executive monitoring (Clark et al., 2003), visually guided task performance (Vasterling et al., 2004; 2000), and control of aggressive impulses (Pavic et al., 2003). Those who recover most from traumatic incidents typically exhibit EEG evidence of dominance restoration (Rabe et al., 2006b).

As we continue to deploy the same warfighters to the Iraqi and Afghan theaters, we need to rapidly identify those who suffer from posttraumatic stress and minimize its impact on performance. Electroencephalographic (EEG) operant conditioning is the culmination of 80 years of scientific inquiry into brain activity and mental function (Berger, 1929; Sterman, 1969; Sterman & Kaiser, 2001). As PTSD often presents itself as a disconnection between cerebral hemispheres, we should first address the EEG rhythm relationship between cerebral hemispheres (EEG coherence and comodulation between homologues). The goal of my future research, if funded, will be to identify PTSD markers in callosal function and restore compromised connectivity with EEG training.

We hope the military higher-ups will listen this time to what is an ultrascientific approach to treatment. It is "ultra" not alternative as all assumptions are empirically validated, all of them!, which is unlike most psychiatric research, which gets 80% of the way to an approach in treatment, leaving the last 20% on the shoulders of the therapist, using his/her clinical judgement, which often amounts to anecdotal analysis and guesswork.

-DK